What do children need from permanent placements?

Observations from an attachment perspective

Dr. Steve Farnfield University of Roehampton London UK Overview

- Attachment
- The parents
- The children
- Assessment
- Interventions What is attachment?

A unique, enduring, and affectively charged relationship (e.g., with one’s mother, with one’s spouse)

A strategy for protecting oneself (of which there are three basic strategies, Types A, B, and C, as identified by Ainsworth, and many sub-strategies, as described by the DMM)

The pattern of information processing that underlies the strategies.

(Crittenden 2008:12) What is attachment?

“Attachment behaviour is the infants’ contribution enabling caregivers to protect and comfort them. Patterns of attachment are infants’ strategies for shaping mother’s behaviour.”

(Crittenden 2005) A strategy is ...

• What we believe will make us safer

• It is a matter of perception

• You can feel anxious or scared when there is no danger

• You can feel safe when under threat The Three Basic Strategies

- Type A: Very COGNITIVE; little affect
- Type C: Little cognition; intense AFFECT
- Type B: Balanced and integrated COGNITIVE and AFFECT A Simplified Dynamic-Maturational Model of Patterns of Attachment

True Cognition

True Negative Affect

False Positive Affect

False Cognition

Psychopathy

Steve Farnfield 2015 The parents Core dimensions intrinsic to parenting

Modifiers type 1 Modifiers type 2

Integration (Information processing) The core dimensions of parenting (Farnfield 2008)

Childhood attachment system

1. The parents state of mind regarding their childhood attachments
2. Parent’s resolution of loss and trauma

The spousal system 3. Pair bonding and sexual partnership

Affiliative / wider support system 4. Kinship, friends and wider support system

Care giving system - parenting 5. The meaning of the child to the parent Modifiers: Type 1. Intra or interpersonal.

a). Mental illness b). Learning disability c). Substance abuse d). Child sexual abuse e). Domestic violence. f). Reconstituted families. g). Adolescent motherhood. Type 2: Socio-political.

- Inherent in cultural / sub cultural or class norms is information about what has enabled the group / culture to survive.

- Includes poverty, economic oppression, racism.

- Stories about the history of dangers faced by the tribe and myths about survival. Type 2 modifiers.: Socio-political.

- Cultural and sub cultural norms with regard to child rearing

- E.g. use of physical punishment; what is acceptable behaviour in girls compared with boys; whether adults play with small children Type 2. Socio-political.

- Because they are culturally normative they are rarely questioned inside the culture.

- But may be at odds with the norms held by outsiders

- **Shame** Type 2. Socio-political.

Moving from one culture to another poses problems if behaviour functional to survival in one culture exposes the family to new dangers or risks in the next. Mentalising refers to the process by which humans attend to “mental states in oneself and others”

It develops throughout child and early adulthood and “is the most fundamental common factor among psychotherapeutic treatments”.

(Allen, Fonagy and Bateman 2008:1) Parenting assessments – do be do

- What parents do
- How parents think about what they do Assessment – families

What they do

- CARE-Index (Hautamaki, 2014)
- Marschak MIM (1960)
- Lausanne Trilogue Play Paradigm (LTP) Fivaz-Depeursinge & Corboz-Warnery 1999
- Observation Assessment - parents

How people think about what they do:

Adult Attachment Interview – dimensions 1&2 (DMM-AII Crittenden & Landini, 2011)

Attachment Style Interview – dimension 3 (Bifulco, 2014)

Questionnaire assessment – dimension 4 (e.g. Family Support Scale, Dunst et al 1993)

Meaning of the Child Interview – dimension 5 (Grey & Farnfield, submitted)

Parent Development Interview – mentalising/ reflective functioning (Slade et al 2005) Why is adult attachment important?

- Secure attachment directly correlates with high level mentalising – and insecure with low level mentalising.
- It holds important information about how the adult reacts to displays of anger and desire for comfort in their child. Adult Attachment Predicts Maternal Brain and Oxytocin Response to Infant Cues

Lane Strathearn, Peter Fonagy, Janet Amico and P Read Montague

Neuropsychopharmacology (2009), 1–12 Children benefit from being placed with alternative carers who are secure on the AAI

- Significant correlation between autonomous (secure) foster mothers and foster children assessed as secure on the SSP.

- Non autonomous foster parents had a disproportionate number of children rated disorganised (Dozier et al. 2001).

- All adopted children made progress in terms of increasing positive representations of attachment themes using the narrative story stem procedure, but those whose adoptive parents were secure on the AAI also showed a decline in negative themes, suggesting resolution of trauma (Steele et al., 2003; see also Beijersbergen et al. 2012). Placement stability

- Foster parent commitment to the child was a strong influence on placement stability.

- The number of children a foster carer had previously cared for was negatively correlated with commitment to the current child, and that the younger the child at the start of fostering the more committed were the carers (Lindhiem & Dozier 2007). Dozier et al found attachment among foster carers did not differ from non-clinical populations (Dozier et al., 2001).

Coram-Anna Freud study (Steele et al., 2008) found more interviews with adoptive mothers were rated secure than expected, but the opposite was true for adoptive fathers.

Santona & Zavattini (2005) Adoptive parents 76% autonomous - secure A study using the DMM-AAI of prospective adoptive parents found only 7% AAIIs were rated balanced-secure and that mothers who already had a child of their own were significantly more likely to be in the range secure/normatively insecure (most often in Type A2) whereas for fathers who already had a child the opposite was the case (Farnfield 2012). North American Safe

- 23% dismissing (A),
- 58% secure (B)
- 19% preoccupied (C)
- 18% for unresolved loss or other trauma

Prospective Adopters

- 46% A or A+
- 13% secure B
- 10% C or C+
- 31% A/C
- 60% for unresolved loss or trauma

(Bakermans-Kranenburg & van IJzendoorn, 2009) (Farnfield, in preparation) n48 (95% applicants to one LA in 1 year) Prospective adoptive parents - unresolved loss & trauma

- No UI/Utr: 19%
- Uloss or Utrauma: 41%
- ULoss&UTrauma: 41% Attachment and reproduction

The function of attachment is to:

- Keep yourself alive
- Long enough to reproduce
- Have grand children
- And pass on your genes Adoption

Challenges all this Disorientation

A DMM modifier

The speaker has a problem locating the source of their memories/information about protection

Over attributes the self as the source of what they know

VC or AC strategy the DMM ratings of disorientation are rare and this sample of adopters is remarkable in that:

21% (n=10) of the interviews were rated disorientated A/C or AC

No difference in terms of sex (5M and 5F)

9 with Uloss or U trauma It seems possible that 21% of applicants were confused regarding whether they wanted to pass on their own genes or those of another couple.

The impact of this on the child is not known. Santona & Zavattini (2005) disorientation to infertility?

Distribution of the forms of "Space Government" The children A Simplified Dynamic-Maturational Model of Patterns of Attachment

True Cognition

True Negative Affect

False Positive Affect

False Cognition

Psychopathy

Steve Farnfield 2015 Attachment

A+ includes:

- Compulsive care giving (role reversal)
- Compulsive compliance (fear)

C+ includes

- Aggressive/helpless
- Punitive / seductive
- Paranoid Attachment and fostered/adopted children face severe dangers:

1. Maltreatment and/or neglect in their family of origin
2. Attachment trauma
3. MOVES within state care
4. Loss of friends/continuity of place Type A/A+

Inhibit things that will displease carers

Do things that will please or placate predictably dangerous carers Compulsive children

• By 3 months infants can inhibit negative affect – the ‘good baby’

• Rigid, robotic (frightened) babies

• Frozen watchfulness

• By 24 months toddlers are able to falsify positive affect – i.e. smile and/or say they are happy when they feel sad or worried

• By 4 years the strategy is perfected into the ‘sunshine effect’ Victoria Climbié 1991 - 2000 She liked to dress up and was given clothes to dress up in by the nursing staff. Nurse Taub would take her to see the babies in the neo-natal ward and bought her sweets and treats. According to Dr Rossiter, she was a “little ray of sunshine”.

(Laming 2003)

“You could beat her and she wouldn’t cry ... She could take the beatings and pain like anything”

Karl Manning Assessment and children

- Strange situation 11 months – 4 years

- Modified strange situation for siblings

- Narrative story stems 3 – 11 years

- School Age Assessment Attachment 6-9 years

- Attachment interviews 6 years onwards

- Various trauma / PTSD scales/ Depression Identity – a memory systems approach Everyone must be who he was in the first years of his life, even if later these were buried under. No one can become what he cannot find in his memories.

- Jean Améry – Auschwitz survivor Identity – what usually happens?

• A core self: 0 - 3/6 months

• A self that knows it exists in the minds of others: 12/18 – 36 months

• Ability to tell a story about the self: 36 months +

• Autobiographical memory: 6 years onwards

• Adolescence: a place for the self in the world Children at most risk of identity crises

1. Multiple moves (2+) in the care system before the age of 6 years

2. Serious and prolonged abuse in infancy / preschool years Identity and life story work

• How can we enable children to generate their own life story?

• Risk of children borrowing semantic statements from professionals

• Identity is clearly not something you get at adolescence The externally assembled self

‘There is no me, I do not exist.’

Peter Sellers Life story work should be:

- Ongoing
- Developmentally appropriate
- Rooted in current experience
- Done in conjunction with the people who were there Identity

The greater part of identity is being known by others - our family or tribe. Memories

We can give children information but we cannot give them memories they do not have Intervention Attachment & Biobehavioral Catch-up (ABC) (Dozier, Lindhiem & Ackerman, 2005)

- Brief home visiting programme for foster parents and foster children.

- Uses video feedback and attends to a foster carer’s state of mind as assessed by the AAI and their This Is My Baby Interview (TIMB) which assesses commitment to the child.

- Intervention children showed more typical levels of the ‘stress hormone’ cortisol than controls and were not significantly different to a third group who had never been in care (Dozier et al., 2008) Home based video feedback

Increase in parent sensitivity increases security of child attachment at any age (Beijersbergen et al, 2102 – longitudinal adoption study)

Improving parents sensitivity is easier than improving child attachment security (see Farnfield & Holmes, 2014) Améry, J. (1999) At the Mind's Limits, Granta.

Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2009). The first 10,000 adult attachment interviews: Distributions of adult attachment representation in non clinical and clinical groups. Attachment & Human Development, 11, 223–263.

Beijersbergen, M. D., Juffer, F. Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H., (2012). ‘Remaining or becoming secure: Parental sensitive Support Predicts Attachment Continuity From Infancy to Adolescence in a Longitudinal Adoption Study,’ Developmental Psychology, 48, 5, Pages 1277–1282

Bifulco, A. (2014) The Attachment Style Interview (ASI), in (eds) S. Farnfield. & P. Holmes, P (2014) The Routledge Handbook of Attachment: Assessment. London: Routledge. Pp 178-191.

Crittenden, P.M. (2005) Keynote Address at the German Association of Infant Mental Health (GAIMH), Hamburg, Germany. www.patcrittenden.com

Crittenden, P.M. (2008) Raising Parents: Attachment, parenting and child safety, Cullompton, Devon UK: Willan.

Crittenden, P.M. and Landini, A. (2011) The Adult Attachment Interview: Assessing Psychological and Interpersonal Strategies, New York and London: W.W. Norton & Co.

Dozier, M., Stovall, K. C., Albus, K. E., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467–1477. Dozier, M., Lindhiem, O. & Ackerman, J.P. (2005) 'Attachment and Biobehavioral Catch-Up: An Intervention Targeting Empirically Identified Needs of Foster Infants,' in L.J. Berlin, Y. Ziv, L. Amaya-Jackson, & M. T. Greenberg, Enhancing Early Attachments: Theory, research, intervention, and policy. New York: The Guilford Press. Pages 178-194.

Dozier et al (2008) 'Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care,' Development & Psychopathology, 20, 3, Pages 845-859.

Dunst, C.J., Trivette C.M. and Hamby, D.W. (1994) ‘Family Support Scale’ in Dunst. C.J., Trivette, C.M., and Deal, A.G., (eds) Supporting and Strengthening Families, MA: Brookline Books.

Farnfield, S. (2014) ‘Assessing attachment in the school years: The application of the dynamic maturational model of attachment to the coding of a child attachment interview with community and looked after children,’ Clinical Child Psychology and Psychiatry, 19 (4) 516-534

Farnfield, S. (2012). Bindung und Anpassung bei Ersatzeltern. In: Stokowy, M., & Sahhar, N. (ed.) Bindung und Gefahr. Das Dynamische Reifungsmodell von Bindung und Anpassung. Giessen: Psychosozial-Verlag. 163-186.

Farnfield, S. & Holmes, P. (2014) (Eds) The Routledge Handbook of Attachment: Assessment. London: Routledge.

Depeursinge, E. & Corboz-Warnery, A (1999) The Primary Triangle: A developmental systems view of mothers, fathers, and infants, New York: Basic Books.

B. & Farnfield, S. (Submitted) ‘The Meaning of The Child Interview (MotC) – A new procedure for assessing the parent-child relationships of ‘at risk’ families: Validity.’

Hautamaki, A. (2014) Mothers and infants: screening for maternal relationships at risk with the CARE-Index. , in (eds) S. Farnfield. & P. Holmes, P (2014) The Routledge Handbook of Attachment: Assessment. London: Routledge. Pp 37-52.

Laming, Lord (2003) The Victoria Climbie Inquiry, London: Crown. Lindhiem, O. & Dozier, M. (2007) ‘Caregiver commitment to foster children: The role of child behavior,’ Child Abuse & Neglect, 31, 4, Pages 361-374.

Marschak, M. (1960) ‘A method for evaluating child-parent interactions under controlled conditions’. Journal of Genetic Psychology, 97, 3-22.

Santona, A. & Zavattini, G.C. (2005) ‘Partnering and parenting expectations in adoptive couples,’ Sexual and Relationship Therapy, 20, 3, Pages 309-322.

Grienenberger, J., Bernbach, E., Levy, D., & Locker, A. (2005). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment & Human Development, 7(3), 283–298.

Hodges, J., Kaniuk, J., Hillman, S., and Henderson, K. (2003) ‘Attachment representations and adoption: associations between maternal states of mind and narratives in previously maltreated children,’ Journal of Child Psychotherapy, 29, 187-205.

Hodges, J., Kaniuk, J., Steele, H., Hillman, S., & Asquith, K. (2008). Forecasting outcomes in previously maltreated children: The use of the AAI in a longitudinal adoption study. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult Attachment Interview (pp. 427–451). New York: Guilford Press. A Dynamic-Maturational Model of Patterns of Attachment in Adulthood

Integrated True Information True Negative

Integrated False Information Distorted Cognition Distorted Affect

Positive Affect False Cognition

Steve Farnfield 2015